Country Progress Report

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GEORGIA

G L O B A L A I D S R E S P O N S E P R O G R E S S R E P O R T N A T I O N A L C E N T E R F O R D E S E A S E

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Global AIDS Response Progress Report

G E O R G I A

Country Progress Report

Reporting Period

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Acknowledgments

Global AIDS Response Progress Report of Georgia 2013 (GARPR) is the result of invaluable

contributions made by various individuals, organizations, and institutions.

We are extremely grateful to representatives of different partner organizations for their

significant input to this report. Namely: Nickoloz Chkhartishvili (Infectious Diseases, AIDS

&Clinical Immunology Research Center); Mzia Tabatadze (Georgia HIV Prevention Project,

USAID); Khatuna Todadze (Center for Mental Health and Prevention of Addiction); Ketevan Stvilia

(Global Fund Projects Implementation Unit, NCDC); Ekaterine Ruadze (Global Fund Projects

Implementation Unit, NCDC); Ketevan Chkatarashvili (Curatio International Foundation);

Nino Tsereteli (Information and Counseling on Reproductive Health “Tanadgoma”); Marine

Gogia (Georgia Harm Reduction Network); Lela Tavzarashvili (Public Union Bemoni); Natalia

Zakareishvili (United Nations Population Fund Georgia);

Nino Mamulashvili (World Health

Organization Country Office, Georgia); Nino Kochishvili (EU Delegation to Georgia); Maia Kajaia

(Health Research Union); Tamar Kheladze (World Vision Georgia);

Preparation and finalization of report was relied heavily upon the professional work and

contribution of the Working Group members from the National Center for Disease Control

and Public Health: Maia Tsereteli, Tsira Merabishvili, Tamar Kikvidze, George Kuchukhidze,

Irma Burdjanadze, Nino Baluashvili, Marina Shakhnazarova, David Baliashvili; Ketevan

Goginashvili from the Ministry of Labor, Health, and Social Affairs; Nino badridze and Otar

Chokoshvili from Infectious Diseases, AIDS and Clinical Immunology Research Center); We

especially acknowledge the leadership and oversight role of NCDC Deputy Directors: Irma

Khonelidze and Ekaterine Kavtaradze.

And, finally our particular thanks must be extended to Dr. Juliette Morgan (US CDC South

Caucasus Office) for devoting considerable time and effort on final editing of the report.

Amiran Gamkrelidze

Director General

National Center for Disease Control and Public Health

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Table

of

Contents

I. Status at a glance ...

5

a) The inclusiveness of the stakeholders in the report writing process

...

5

b) The status of HIV/AIDS epidemic in Georgia

...

5

c) The Policy and Programmatic Response

...

6

d) Indicator Data in an overview table

...

8

II. Overview of the AIDS epidemic ...

19

III. National Response to the AIDS Epidemic ...

22

IV. Best Practices ...

24

V. Major Challenges and Remedial Actions ...

26

VI. Support from the Country’s Development Partners ...

27

VII. Monitoring and Evaluation Environment ...

34

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Acronyms

AIDS Acquired Immune Deficiency Syndrome

AIDS Center Infectious Diseases, AIDS & Clinical Immunology Research Center

ANC Antenatal Clinics

ARV/ART Antiretroviral drugs / Antiretroviral therapy

Bio-BSS Behavioral Surveillance Surveys with biomarker component

CCM Country Coordinating Mechanism

CIF Curatio International Foundation

FSWs Female Sex Workers

GARP Global CountryProgress Report

GEL Georgian Lari

GHPP Georgian HIV Prevention Project

GIP Global Initiative on Psychiatry

GoG Government of Georgia

GFATM Global Fund to fight AIDS, Tuberculosis and Malaria

HIV Human Immunodeficiency Virus

HR Human Resources

IDUs Injecting Drug Users

IOM International Organization on Migration

LSBE Life-skills based Education

MARPs Most-at-risk populations

MCCU Mother and Child Care Union

M&E Monitoring & Evaluation

MoES Ministry of Education and Science of Georgia

MoC Ministry of Corrections of Georgia

MoLHSA Ministry of Labor, Health and Social Affairs of Georgia

MSM Men who have sex with men

NCDCPH National Center for Disease Control and Public Health

NIS New Independent States

NSPA National Strategic Plan of Action

NCPI National Commitments and Policy Instrument

OIs

OST Opportunistic infectionsOpioid Substitution Therapy

PLWH People living with HIV

PTF STI/HIV Prevention Task Force

SOPs Standard Operating Procedures

STIs Sexually Transmitted Infections

TB Tuberculosis

UNAIDS Joint United Nations Programme on HIV/AIDS

UNDP United Nations Development Programmed

UNICEF United Nations Children’s Fund

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I. Status at a glance

a)

The inclusiveness of the stakeholders in the report writing process

As per recommendations from the UNAIDS Executive Director, Mr. Michel Sidibe, the Ministry of Labor, Health&Social Affairs of Georgia granted approval for the process to compile the Global AIDS Response Progress Report to meet the submission deadline of the 31 March 2014.The National Center for Disease Control and Public Health (NCDCPH) led the participatory and multi-stakeholder process of compiling the Country Report.

In accordance with recommendations from the Guideline on Construction of Core Indicators for Monitoring the 2011 Political Declaration on HIV/AIDS, the Country Progress Report was developed through several national consultation meetings as well as individual meetings with the key stakeholders and desk reviews. Data for specific indicators were reviewed by experts from governmental, non-governmental, and international organizations. Based on UNAIDS recommendations, data for each national indicator as well as the draft Country Progress Report were shared, discussed and validated among the representatives of the Government of Georgia and other state and non-state actors, both national and international.

This Country Progress Report was developed in a participatory manner, with overall coordination from the NCDCPH and Country Coordinating Mechanism (CCM). All consultations and relevant data collection endeavors have been directly facilitated by the Department of HIV/AIDS, Tuberculosis, STI & Hepatitis of the NCDCPH.

National Commitments and Policy Instrument (NCPI) was also developed through participatory meetings of Government and non-state actors separately. After developing a first draft of the NCPI, it was circulated with the wider audience allowing all stakeholders to comment on the draft. All the comments were discussed and incorporated into the final report.

A letter from the CCM’s Chairperson was circulated among the different stakeholders in order to collect information regarding domestic and international AIDS spending, by categories and financing sources, to complete the National Funding Matrix.

b

The 2014 Dublin Declaration Questionnaire, elaborated by the European center for Disease Control (ECDC) was also completed by representatives from government agencies who have a solid understanding of the country’s HIV response (Part A), and by representatives from civil society who are actively engaged in that response (Part B).

14 DUBLIN DECLARATION QUESTIONNAIRE

b)

The status of HIV/AIDS epidemic in Georgia

Georgia is among low HIV prevalence (0.07%) countries being at high risk for an expanding epidemic due to widespread injecting drug use and the population movement between Georgia and neighboring high HIV prevalence countries such as Ukraine and Russia. The number of People Living With HIV (PLWH) in country was estimated to be 6640 (Spectrum EPP), although 3641 PLWH were officially registered by the end of 2012 and 4131 PLWH - by the end of 2013. The first case of HIV infection was detected in 1989. From 1989 to 1996 only few cases of HIV infection were registered in the country. Since 1997 the number of newly registered cases started to increase steadily and reached 526 in 2012 and 490 in 2013.

In the early years of the HIV epidemic in Georgia, as in most Eastern European countries, injecting drug use was the major transmission mode. Since 2010, transmission has shifted toward the heterosexual mode, which became dominant by 2011. The percentage of drug use, as a transmission mode among newly registered HIV cases has decreased from 43.2 % in 2012 to 35% in 2013 while heterosexual transmission has increased from 44.8% in 2012 to 49% in 2013 (see Figure 2).

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The HIV epidemic is primarily restricted to the most-at-risk populations (MARP) – People Who Inject Drugs (PWID), , Men who have sex with Men (MSM), Female Sex Workers (FSWs) and prisoners. The results from the most recent Bio-Behavioral Surveillance (Bio and BSS studies?) 2012 among MSM demonstrated 13% HIV prevalence in Tbilisi. The epidemic among PWID, FSWs and prisoners is of lower magnitude. According to the Bio-BSS studies conducted in 2012 the HIV prevalence among PWID was 3.0% and 1.1% among FSWs in 2012. The HIV prevalence among prisoners has decreased from 1.4% in 2008 to 0.3% in 2012.

All the data on HIV-related knowledge, attitudes and behavior, as well as HIV prevalence indicators for MARPs – presented in the Bio-BSS reports of 2012, point to the high risk for HIV epidemic expansion among the key populations and from them to the general public.

c)

The Policy and Programmatic Response

The Government of Georgia is strongly committed to HIV/AIDS epidemic prevention and control since 1996 when the first State HIV Prevention Program was developed. Since 2007, in response to the UNAIDS “Three Ones” principle, the CCM was given the power of Georgia’s sole National Coordinating Authority on HIV, TB and Malaria and started operating with full multi-sector mandate.

The CCM has been actively coordinating the national response, and includes broad representation from all relevant ministries, government institutions, the UN, civil society organizations, bilateral and multilateral agencies, as well as organizations representing people living with HIV. In order to enhance representation of the civil sector within the CCM, three community based organizations representing PLWH, LGBT (lesbian, gay, bisexual, transgender) community and drug users were selected as CCM members in 2013.

The HIV prevention task force (PTF), uniting the NGOs working on HIV, is another effective professional and civil society forum of stakeholders actively involved in HIV policy development and advocacy initiatives in Georgia.

In 2009-10, with technical and financial support from UNAIDS, the new National Strategic Plan of Action (NSPA) 2011-16 was developed through intensive participatory, inclusive and interactive process. Over 50 key national experts, policy makers, civil society and international stakeholders were directly involved in the series of National Consultations and have greatly contributed to the process. The NSPA 2011-16 is aligned to the UNAIDS Outcome Framework (Priority Areas 1, 3, 5, 7 and 9, selected on National Consultations in October 2009) and provides ample space for realizing The Three Zeros eliminating HIV/AIDS and achieving HLM 2011 commitments in Georgia. In 2013, with support of UNAIDS, the NSPA financial gap analysis was completed. The funding allocations from the national, and bi and multilateral donor organizations were analyzed for 2011 and 2012. The analysis has revealed substantial gaps in NSPA funding and high reliance on the external financial assistance, mainly from GF and USAID.

Based on the financial gap analysis and the latest BSS data the CCM plans to conduct the midterm review of the NSPA in 2014. It will be aimed at aligning the funding allocations to the interventions targeting the population groups at the higher risk for HIV transmission. The midterm review will allow the country to budget effectively the state HIV programs in coming years, to fill the gap and ensure sustainability of GF program funded interventions starting from 2016 when the GF’s support for Georgia will be substantially lower.

With the technical support from the UNAIDS country office, the NCDCPH of Georgia has organized a Team of Local Experts (TLE) that worked on the stocktaking exercise and put considerable efforts to make sure that the report is based on the comprehensive review of the evidence from all potential

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participation of all main stakeholders in order to draw sound recommendations providing the GoG, NCDCPH and other interested parties with solid basis for future informed decisions.

The draft summary report of findings and recommendations was elaborated for the identified priority targets and was circulated among the key partners and the working group members during a week and was officially presented at the National Stakeholders Consultation meeting on May 29, 2013. The final report was endorsed on May 31, 2013.

In September, 2013 through transparent competitive process, the NCDCPH was selected as the principal recipient of The Global unds grants in Georgia in both directions: HIV and TB. The phase 2 of current Global Fund’s HIV program will be implemented from April 2014 till 31st_{of December 2015.}

The NCDCPH being the PR of TGF projects in Georgia as well as the key responsible agency for disease surveillance will be able to better coordinate and consolidate state and donor funds. During transition period the NCDCPH will assist the MoLHSA to prepare the strategy ensuring the successful takeover of the TGF programs by the country in 2016.

The current GF HIV program provides substantial funding to HIV prevention, treatment, care and support, with the goal of reducing transmission of HIV among MARPs and mortality among PLWHIV in Georgia.

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d)

Indicator Data in an overview table

Target 1. Halve sexual transmission of HIV by 2015

Indicator #1.1 Value Comment

Percentage of young women and men aged 15-24 who both correctly identify ways of preventing

the sexual transmission of HIV and who reject major misconceptions about HIV

transmission. (percentage of respondents who gave correct answer to

all 5 questions)

All Males Females M

15-19 20-24 M F 15-19 F 20-24

BSS among School Pupils and University Students in Tbilisi, Georgia, 2011;The statistical population of the BSS among youth was all students 15-24 years of age

attending public (state) or private: a) secondary schools (9th to 12th grades), b) undergraduates in private or public universities; and c) students in

vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using probability-proportional-to-size sampling. Survey data were collected through a

self-administered, anonymous questionnaire. The survey was conducted only in the capital

city, and therefore the findings cannot be

generalized to youth nationwide. Another limitation of the BSS was that the survey was conducted only among youth who were enrolled or attending either public or private

school at the time of the survey. Therefore, youth not enrolled in schools/universities

were not included. 10.22% 11.23% 9.25% 9.47% 15.65% 6.60% 14.84%

All Males Females M 15-19 M 20-24 F 15-19 F 20-24

Question 1: “Can the risk of HIV transmission be

reduced by having sex with only one uninfected partner who has no other

partners?”

66.74% 66.30% 67.15% 64.27% 71.37% 62.88% 76.13%

BSS among School Pupils and University Students in Tbilisi, Georgia, 2011;The statistical population of the BSS among youth was all students 15-24 years of age

attending public (state) or private: a) secondary schools (9th to 12th grades), b) undergraduates in private or public universities; and c) students in

vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using probability-proportional-to-size sampling. Survey data were collected through a

self-administered, anonymous questionnaire. The survey was conducted only in the capital

generalized to youth nationwide. Another limitation of the BSS was that the survey was conducted only among youth who were enrolled or attending either public or private

school at the time of the survey. Therefore, youth not enrolled in schools/universities

were not included.

All Males Females M 15-19 M 20-24 F 15-19 F 20-24

Answered Yes to Question 2: “Can a person reduce the risk for getting HIV by using a condom every time

they have sex?”

65.46% 72.08% 59.15% 72.06% 72.14% 54.45% 69.03%

BSS among School Pupils and University Students in Tbilisi, Georgia, 2011;The statistical population of the BSS among youth

was all students 15-24 years of age attending public (state) or private: a) secondary schools (9th to 12th grades), b) undergraduates in private or public universities; and c) students

in vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using

probability-proportional-to-size sampling. Survey data were collected through a

self-administered, anonymous questionnaire. The survey was conducted only in the capital

generalized to youth nationwide. Another limitation of the BSS was that the survey was conducted only among youth who were enrolled or attending either public or private school at the time of the survey. Therefore, youth not enrolled in schools/universities were

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All Males Females M 15-19 M 20-24 F 15-19 F 20-24 Answered Yes to Question

3: “Can a healthy-looking person have HIV”?

49.33% 47.44% 51.14% 46.26% 50.38% 48.47% 56.77%

BSS among School Pupils and University Students in Tbilisi, Georgia, 2011;The statistical population of the BSS among youth was all students 15-24 years of age attending public (state) or private: a) secondary schools (9th to 12th grades), b) undergraduates in private or public universities; and c) students in

vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using probability-proportional-to-size sampling. Survey data were collected through a self-administered, anonymous questionnaire. The survey was conducted only in the capital

generalized to youth nationwide. Another limitation of the BSS was that the survey was conducted only among youth who were enrolled or attending either public or private school at the time of the survey. Therefore,

youth not enrolled in schools/universities were not included.

All Males Females M 15-19 M 20-24 F 15-19 F 20-24 Correct answer to

Question 4: “Can a person get HIV from mosquito

bites?” (Or country

specific question.)

26.72% 28.35% 25.16% 26.87% 32.06% 22.70% 30.32%

vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using probability-proportional-to-size sampling. Survey data were collected through a self-administered, anonymous questionnaire. The survey was conducted only in the capital

city, and therefore the findings cannot be

All Males Females M 15-19 M 20-24 F 15-19 F 20-24 Correct answer to

Question 5: “Can a person get HIV from sharing food with someone who is infected?” (Or country

specific question.)

46.78% 44.27% 49.17% 41.37% 51.53% 45.40% 57.10%

vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using probability-proportional-to-size sampling. Survey data were collected through a self-administered, anonymous questionnaire. The survey was conducted only in the capital

generalized to youth nationwide. Another limitation of the BSS was that the survey was conducted only among youth who were enrolled or attending either public or private school at the time of the survey. Therefore,

Indicator #1.2 All Males Females M 15-19 M 20-24 F 15-19 F 20-24 Comment

Percentage of young women and men aged

15-24 who have had sexual intercourse before the age

of 15

11.44% 23.34% 0.10% 25.50% 17.94% 0.15% 0.00%

BSS among School Pupils and University Students in Tbilisi, Georgia, 2011; The statistical population of the BSS among youth was all students 15-24 years of age attending public (state) or private: a) secondary schools (9th to 12th grades), b) undergraduates in private or public universities; and c) students in

vocational-technical training schools in Tbilisi, the capital city of Georgia. A total of 1879 respondents were chosen randomly using probability-proportional-to-size sampling. Survey data were collected through a self-administered, anonymous questionnaire. The survey was conducted only in the capital

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Indicator#1.3 All

Females Females F 15-19 F 20-24 F 25-49 Comment

Percentage of respondents aged 15-49 who have had sexual intercourse with more than one partner in

the last 12 months

0.52% 0.52% 0.35% 0.45% 0.58%

The data has been taken from the Georgian Reproductive Health

survey The survey population included females between the

ages 15 and 44 years,

Data for males N/A

Females Females F 15-19 F 20-24 F 25-49 Comment

Percentage of women and men aged 15-49 who had more than one partner in the past 12 months who used a condom during their

last sexual intercourse

18.18% 18.18% 0% 0% 24.00%

survey The survey population included females between the

Data for males N/A

Females Females F 15-19 F 20-24 F 25-49 Comment

Percentage of women and men aged 15-49 who received an HIV test in the

last 12 months and who know their results

6.45% 6.45% 3.02% 10.65% 6.12%

survey The survey population included females between the

Data for males N/A

Indicator#1.6 All 15-19 20-24 Comment

Percentage of young people aged 15-24 who are

living withHIV. 0.03% 0.03% 0.03%

HIV routine Surveillance Database

Indicator#1.7 All FSW_FSW <25 25+ Comment

Percentage of sex workers who replied “Yes” to both

questions 65.00% 32.00% 68.24%

Source: BSS among FSWs in Tbilisi, Batumi –2012 y. N=280

(Male Sex Workers N/A) Percentage of sex workers

who replied Yes to Question 1, “Do you know

where you can go if you wish to receive an HIV

test?”

81.43% 56.00% 83.92%

Source: BSS among FSWs in Tbilisi, Batumi –2012 y. N=280

(Male Sex Workers N/A)

Percentage of sex workers who replied Yes to Question 2 “In the last 12

months, have you been given condoms?”

72.14% 48.00% 74.51%

Indicator#1.8 All FSW <25 25+ Comment

Percentage of female and male sex workers reporting

the use of a condom with their most recent client.

91.07% 100% 90.20%

Indicator#1.9 All FSWFemales <25 25+ Comment

Percentage of CSWs who received an HIV test in

the last 12 months and who knows their results

42.14 % 44.00% 41.96 %

Indicator#1.10 All FSW <25 25+ Comment

Percentage of sex workers

who are living with HIV 1.09 % 0.00% 1.19% Tbilisi, Batumi –Source: BSS among FSWs in 2012 y. N=280 (Male Sex Workers N/A)

Indicator#1.11 All MSM <25 25+ Comment

Percentage of MSM who answered “Yes” to both

questions 48.6 % 33.7 % 57.8 %

Bio-behavioral surveillance survey among men who have sex with men in Tbilisi, Georgia

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All MSM <25 25+ Percentage of MSM

who answered “Yes” to Question 1, “Do you know

where you can go if you wish to receive an HIV

test?”

77.5 % 69.9% 82.2%

Bio-behavioral surveillance survey among men who have sex with men in Tbilisi, Georgia

(2012)

All MSM <25 25+

Percentage of MSM who answered “Yes” to Question 2 “In the last 12

months, have you been given condoms? “

53.7 % 41% 61.5%

(2012)

Indicator# 1.12 All MSM <25 25+ Comment

Percentage of MSM who reported that a condom was used the last time they

had anal sex

73.2 % 76.3% 71.3 %

(2012)

Percentage of men who have sex with men who received an HIV test in the

past 12 months and know their results

33.94 % 28.92 % 37.04 %

Bio-behavioral surveillance survey among men who have sex with men in Tbilisi, Georgia

(2012)

Percentage of men who have sex with men who are

living with HIV 12.96 % 2.99 % 29.27 %

(2012)

Indicator# 1.16

All (15+) _Males(15+)

Females (15+) _{Both sexes}

(15-19)

Males (15-19) Females (15-19) Both sexes

(20-24)

Males (20-24) _{Females (20-24)} _{Both sexes (25+)} Males (25+) Females (25+)

Comment

Number of people who received HIV testing and counselling in the past 12 months and know their

results

12749 9762 2987 456 346 11

0

1480 1156 324 ₁₀₈₁₃ ₈₂₆₀ ₂₅₅₃ HIV Routine Surveillance Database Females (15+) Females

(15-19) Females (20-24) Females (25+) Number of pregnant

women aged 15 and older (out of the total number

above) who received testing and counsellingin

the past 12 months and receivedtheir results

22 1 3 18

HIV Routine Surveillance Database

Indicator# 1.16EURO Injecting

drug users Sex between men Heterosexual contact Mother-to-child transmission

Other Unknown Comment Disaggregation by mode

of transmission: HIV Testing and counselling

35% 13% 49% 1% 1% 1%

HIV Routine Surveillance

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Indicator# 1.16.1 % Comment Percentage of health

facilities dispensing HIV rapid test kits that experienced a stock-out in

the last 12 months

0

State program and Global Fund

Indicator# 1.17.1 Females Comment

Percentage of women accessing antenatal care (ANC) services who were

tested for syphilis at first

ANC visit

85.5%

Statistics Department, National Centre for Disease Control and

Public Health Percentage of women

accessing antenatal care (ANC) services who were

tested for syphilis at any ANC visit

85.5 %

Public Health

Indicator# 1.17.2 Total <25 25+ Comment

Percentage of antenatal care attendees who were

positive for syphilis 0.2% N/A N/A

Public Health. No data disaggregated by age

groups available.

Indicator# 1.17.3 % Comment

Percentage of antenatal care attendees positive for syphilis who received

treatment

N/A

Percentage of sex workers

with active syphilis N/A

Percentage of men who have sex with men with

active syphilis N/A

Indicator# 1.17.6 Total Females Males Female

(primary/ secondary) Male (primary/ secondary) Comment

Number of adult reported with syphilis (primary/

secondary and latent/ unknown) in the past 12

months

1089 554 535 81 119

Public Health.

Indicator# 1.17.7 # Comment

Number of reported congenital syphilis cases (live births and stillbirths)

in the past 12 months

N/A

Indicator# 1.17.8 Total Comment

Number of men reported with gonorrhea in the past

12 months 527

Statistics Department, National Centre for Disease Control and

Public Health.

Number of men reported with urethral discharge in

the past 12 months N/A

Number of adults reported with genital ulcer disease

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Target 2. Reduce transmission of HIV among people who inject drugs by 50 per cent by 2015

Indicator# 2.1 Total Comment

Number of needles and syringes distributed per person who injects drugs

per year by Needle and Syringe Programs

45.3

The data are aggregated according to databases from each center.

Indicator# 2.2 All Males Females <25 25+ Comment

Percentage of people who inject drugs reporting the use of a condom the last time they had sexual

intercourse

34.46% 34.48% 33.33% 50.29% 32.59%

BSS study N=1791. The PWIDs were studied in six different locations of Georgia: Tbilisi, Gori, Telavi, Zugdidi, Kutaisi and Batumi

in 2012.

Percentage of people who inject drugs reporting the use of sterile injecting

equipment the last time they injected

83.47 % 83.38% 90.91% 87.71% 83.00%

in 2012.

Percentage of people who inject drugs who received an HIV test in the past 12 months and know their

results

14.68% 14.36% 40.91% 6.70 % 15.57 %

in 2012.

Percentage of people who inject drugs who are living

with HIV 3.04 % 3.08 % 0.00 % 1.13 % 0.31 %

BSS study N=1791. The PWIDs were studied in six different locations of Georgia: Tbilisi, Gori, Telavi, Zugdidi, Kutaisi and Batumi

in 2012.

Indicator# 2.6a # Comment

Estimated number of opiate users (injectors and

non-injectors) N/A

State program and Global Fund

Indicator# 2.6b N: Comment

Number of people on opioid substitution therapy

(OST) 4613

cumulative number of the patients on OST treatment during 2013.

Indicator# 2.7a N: Comment

Number of needle and syringe program (NSP)

sites

14

Within GF project in September 2013 here was added 4 service sites

- 2 in the capital and 2 in regions, totally 14 harm reduction sites are operating from this period. All service centers provide data

in database which is unified for

all facilities/NGOs working with MARPs.

Indicator# 2.7b N: Comment

Number of substitution

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Target 3. Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS-related maternal deaths

Indicator# 3.1 % Comment

Percentage of HIV-positive pregnant women who received antiretrovirals to reduce the

risk of mother-to-child transmission 76.36 %

Denominator represents estimate derived from Spectrum. We believe that 55 is an overestimate

of actual number given that country ensures universal screening of pregnant women and

their linkage to HIV services.

In 2013 42 HIV positive women were identified

countrywide and all of them received PMTCT services.

Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS

Health Information System Numerator: Number of HIV-positive pregnant

women who received antiretroviral drugs during the past 12 months to reduce the risk of

mother-to-child transmission during pregnancy and delivery

42

Denominator: Estimated number of HIV-positive pregnant women who delivered within

the past 12 months 55

Indicator# 3.1a # Comment

Percentage of women living with HIV who are provided with antiretroviral medicines for themselves or their infants during the

breastfeeding period

N/A

Indicator# 3.2 Comment

Percentage of infants born to HIV-positive women receiving a virological test for HIV

within 2 months of birth 45.45 %

Denominator represents estimate derived from Spectrum. We believe that 55 is an overestimate of actual number given that country ensures universal screening of pregnant women and their linkage to HIV

services.

In 2013 25 infants were born to HIV positive women and all of them received virologic test. Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS Health

Information System

Numerator: Number of infants who received an HIV test within two months of birth, during the reporting period. Infants tested should only

be counted once

25

Denominator: Number of HIV-positive pregnant women giving birth in the last 12

months 55

Indicator# 3.3 Comment

Estimated percentage of child HIV infections from HIV-positive women delivering in the

past 12 months 10.9%

Spectrum EPP.

Percentage of pregnant women who were tested for HIV and received their results – during pregnancy, during labor and delivery,

and during the post-partum period (<72 hours), including those with previously

known HIV status

86%

86% - this figure is just the percentage of pregnant

women who were tested for HIV and received their results during the pregnancy at the Antenatal clinics (ANC). (source NCNCPH Department of Statistics)

Percentage of pregnant women attending antenatal care whole male partner was tested

for HIV in the last 12 months N/A

Indicator# 3.6 Comment

Percentage of HIV-infected pregnant women assessed for ART eligibity through either

clinical staging or CD4 testing 68%

Denominator represents estimate derived from Spectrum. We believe that 62 is an overestimate of actual number given that country ensures universal screening of pregnant

women and their linkage to HIV services.

In 2013 42 HIV positive women were identified

countryode and all of them were assessed for ART eligibility, onlcuding CD4 testing Source: Infectious Diseases, AIDS and Clinical

Immunology Research Center, National AIDS Health Information System Numerator: Number of HIV-infected pregnant

women assessed for ART eligibility 42

Denominator: Estimated number of HIV-infected pregnant women

(16)

Indicator# 3.7 Comment Percentage of infants born to HIV-infected

women provided with antiretroviral prophylaxis to reduce the risk of early

mother-to-child transmission in the first 6

weeks

40.3 %

Denominator represents estimate derived from Spectrum. We believe that 62 is an overestimate of actual number given that country ensures universal screening of pregnant

women and their linkage to HIV services. In 2013 25 infants were born to HIV positive women and all of them received prophilcatic

ART

Numerrator is derived from the national AIDS Health Information System operated by the Infectious Diseases, AIDS and Clinical

Immunology Research Center. Numerator: Number of infants born to

HIV-infected women who received antiretroviral prophylaxis to reduce early mother-to-child

transmission (early postpartum, in the first 6

weeks)

25

Denominator: Estimated number of

HIV-infected pregnant women giving birth ₆₂

Indicator# 3.9 Comment

Percentage of infants born to HIV-infected women started on cotrimoxazole (CTX) prophylaxis within two months of birth

40.3% Denominator represents estimate derived from Spectrum. We believe that 62 is an overestimate of actual number given that country ensures universal screening of pregnant women and their linkage to HIV

services.

Numerator: ₂₅ In 2013 25 infants were born to HIV positive women

and all of them received CTX prophilcatxis

Denominator:

62 Immunology Research Center, National AIDS Health Source: Infectious Diseases, AIDS and Clinical Information System

Distribution of feeding practices (exclusive breastfeeding, replacement feeding, mixed

feeding/other) for infants born to HIV-infected women at DPT3 visit

N/A

Indicator# 3.11 Comment

Number of pregnant women attending ANC

at least once during the reporting period 88024

Indicator# 3.11.1 Comment

Percentage of HIV-positive women who had

their pregnancy terminated 8.3% Immunology Research Center, National AIDS Health Source: Infectious Diseases, AIDS and Clinical _{Information System}

Indicator# 3.11.2 Comment

Percentage of HIV-positive pregnant women

who delivered during the reporting year 69% Immunology Research Center, National AIDS Health Source: Infectious Diseases, AIDS and Clinical Information System

Percentage of HIV-positive pregnant women

who were injecting drug users 0% Immunology Research Center, National AIDS Health Source: Infectious Diseases, AIDS and Clinical Information System

Percentage of HIV-positive pregnant PWID

women who received OST during pregnancy 0% reports from OST facilities.

Percentage of HIV-positive pregnant PWID women who received ARVs to reduce the

of mother-to-child transmission during pregnancy

0%

Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS Health

(17)

Target 4. Have 15 million people living with HIV on antiretroviral treatment by 2015

Indicator# 4.1 All Male Females Comment

Percentage of adults and children currently receiving antiretroviral therapy among all adults and children

living with HIV

31.5 % 27.8 % 43.2 %

Denominator represents estimate of total number people living with HIV derived from Spectrum, that is why indicator is

below 50%.

When indicator is clacluated using Spectrum derived estimated number of HIV

patients eligible for ART, than indicator value is 80% (2092/2620). When indicator is calculated using number

eligible HIV patients among those already diagnosed, the indicator value is greater

than 90%of persons (2092/2295) Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS Health Information System Numerator: Number of adults and

children currently receiving antiretroviral therapy in accordance with the nationally approved treatment protocol (or WHO

standards) at the end of the reporting period.

2092 1405 687

Denominator: Estimated number of adults and children living with HIV

6640 5050 1590

<15 15+ <1 1-4 5-9 10-14 15-19 20-24 15-49 50+ unknownAge Comment Percentage of adults and

children currently receiving antiretroviral therapy among

all adults and children living with HIV

63.4% 31.2%

Indicator# 4.2a All Males Females <15 15+ Comment

Percentage of adults and children with HIV known to

be on treatment 12 months after initiation treatment among patients initiating antiretroviral therapy 85.5 % 83.1 % 90.6 % 100% 85.3 % Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS Health Information System

Indicator# 4.2b All Males Females <15 15+ status at start Pregnancy of therapy

Breastfeeding ststus at start

of therapy Comment

Percentage of adults and children with HIV still alive and known to be on antiretroviral therapy 24 months after initiating treatment among patients

initiating antiretroviral therapy during2011 82.1% 82.1% 82.1% 85.7% 80.9% Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS Health Information System

Indicator# 4.2c All Males Females <15 15+ status at start Pregnancy of therapy

Breastfeeding ststus at start

of therapy Comment

Percentage of adults and children with HIV still alive and known to be on treatment

60 months after initiating antiretroviral therapy (from

2008) 71.3% 66.2% 87.2% 81.8 Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, National AIDS Health Information System

Indicator# 4.2c All 25+ <25 Comment

Percentage of injecting drug users with HIV still alive and known to be on treatment 12 months after initiation of

antiretroviral therapy

80.1% 80.2% 79.5% and Clinical Immunology Research Source: Infectious Diseases, AIDS _{Center, National AIDS Health}

(18)

Indicator# 4.2.1b All Comment Percentage of injecting drug

users with HIV still alive and known to be on treatment 24 months after initiation of

antiretroviral therapy

79.1% _{Research Center, National AIDS Health Information System}Source: Infectious Diseases, AIDS and Clinical Immunology

Indicator# 4.2.1c All Comment

Percentage of injecting drug users with HIV still alive and known to be on treatment 60 months after initiation of

antiretroviral therapy

59.4% _{Research Center, National AIDS Health Information System}Source: Infectious Diseases, AIDS and Clinical Immunology

Indicator# 4.3a N Comment

Total number of health facilities that offer

antiretroviral therapy (ART) 5

Source: Infectious Diseases, AIDS and Clinical Immunology Research Center

Indicator# 4.3b N Comment

Health facilities that offer paediatric antiretroviral

therapy (ART) 5

Source: Infectious Diseases, AIDS and Clinical Immunology Research Center.

Indicator# 4.4 Total Comment

Percentage of health facilities dispensing ARVs that experienced one or more stock-outs of at least one required ARV drug in the last

12 months.

0% Source: Infectious Diseases, AIDS and Clinical Immunology _{Research Center.}

Indicator# 4.6 All Males Females Sex un <15 15+ Age un Comment

4.6.a

Total number of adults and children enrolled in HIV care at the end of the

reporting period

2369 1629 740 0 51 2318 0

Source: Infectious Diseases, AIDS and Clinical Immunology

Research Center, National AIDS Health

4.6.b

Number of adults and children newly enrolled

in HIV care during the reporting period

439 321 111 0 3 436 0

Indicator# 4.7a All Males Females Sex un <15 15+ Age un Comment

Percentage of people on ART tested for viral load

who have a suppressed viral load in the reporting

period

81.2% 82.3% 78.9% 73.8% 81.4%

Research Center, National AIDS Health

Indicator# 4.7b All Males Females Sex un <15 15+ Age un Comment

Percentage of people on ART tested for viral load

(VL) with VL level ≤ 1000

copies/ml after 12 months of therapy

84.3% 85.6% 81.6% 100 84.2%

Source: Infectious Diseases, AIDS and Clinical Immunology

Research Center, National AIDS Health

(19)

Target 5. Reduce tuberculosis deaths in people living with HIV by 50 per cent by 2015

Indicator# 5.1 All Males Females <15 15+ Comment

Percentage of estimated HIV-positive incident TB cases that received treatment for TB and

HIV

88 %

Source: Infectious Diseases, AIDS and Clinical Immunology Research Center, national electronic database for HIV aids care and support program and

Tuberculosis patient registries and WHO TB/HIV estimation

Indicator# 5.2 All Males Females Sex un <15 15+ _unknownAge Comment

Percentage of adult and children living with HIV newly enrolled in care who

are detected hiving active TB disease

7.5% 9.5% 1.8% 0 7.6% 0

Research Center

Percentage of adult and children newly enrolled in HIV care starting isoniazid

preventive therapy (IPT)

21 % Source: Infectious Diseases, AIDS and Clinical Immunology _{Research Center.}

Indicator# 5.4 Total Comment

percentage of adults and children enrolled in HIV care

who had TB status assessed and recorded during their last

visit

100% Source: Infectious Diseases, AIDS and Clinical Immunology _{Research Center}

Target 7. Critical enablers and synergies with development sectors

Indicator# 7.1

Females All HIV

+ Females

HIV

- Females

Females (15-19) HIV+ Females (15-19) HIV

- Females (15-19)

Females (20-24) HIV+ Females (20-24) HIV

- Females (20-24)

Females (25-49) HIV+ Females (25-49) HIV

- Females (25-49)

Comment

Proportion of ever-married or partnered women aged

15-49 who experienced physical or sexual violence

from a male intimate partner in the past 12

months 1.87 % 5.38 % 2.19 % 1.69 %

The data has been taken from the Georgian Reproductive Health survey

(RHS)

Percenage of women and men aged 15-49 who report

discriminatory attitudes towards people living with

HIV

N/A

Current scool attence among orphans and non-orphans (10-14 years old, primary school age, secondary school age)

N/A

Proportion of the poorest househlods who received external economic support in

the last 3 months

(20)

II. Overview of the AIDS epidemic

The first case of HIV in Georgia was detected in 1989. Thereafter the number of annually detected cases has been relatively small. Georgia is one of those very few countries in the world and in the region where the HIV incidence has been increasing steadily during the last decade.

Figure 1: HIV/AIDS prevalence and incidence rates 2005-2013 (per 100 000)

16.5 21.5 28.1 35 42.1 48.5 55.1 63.2 72.1 5.5 6.3 7.8 7.7 7.8 9.9 9.5 11.7 _10.9 0 10 20 30 40 50 60 70 80 2005 2006 2007 2008 2009 2010 2011 2012 2013 prevalence incidence

Despite a relatively low prevalence rate, the HIV/AIDS epidemic remains a significant public health concern in Georgia. There were 4131 HIV/AIDS registered cases in the country by the end of 2013. The HIV epidemic is largely concentrated among males and high-risk groups such as IDUs, MSM and FSW. HIV estimated prevalence ranges from 0,4 to 9,1% among IDUs, and 0,8%-1,3% among FSWs depending on locality. HIV prevalence increase has shown steady and alarming trend among MSM in Tbilisi (the capital city), from 7% in 2010 to 13% in 2012.

HIV prevalence among pregnant women and blood donors is lower (0.04% in both sub-populations) than in general population (0.07% in 2013).

The epidemiological distribution of the disease by gender and age indicates more cases among the 25-40 age groups. The biggest difference between the number of infected men and women was also detected in this age group (25+), while the gender difference is minimal among the 15-24 year olds. In previous years, the proportions of male and female HIV+ cases were 75% and 25% respectively. In 2011, the proportion was changed, with males accounting for 70% of cases and females for 30%. This shift would be explained by the spread of HIV among sexual partners of IDUs. The trend is still maintained in last two years.

Georgia is facing critical challenges such as drug abuse and related health and social consequences. Similar to the most Eastern European countries, injecting drug use was the major transmission mode in the early years of the HIV epidemic in Georgia. Since 2009, transmission has shifted toward the heterosexual mode (Figure 2.) which became dominant by 2011 and the trend escalated in 2013.

(21)

Figure 2: Percentage mode of HIV transmission by year 0 10 20 30 40 50 60 70 2007 2008 2009 2010 2011 2012 2013 %

Injecting Drug Use

Heterosexual Contacts Homosexual Contacts Blood Transfussion Mother-to-Child Transmission Unknown

Over the past few years, Georgian government, together with international donor organizations, has been strengthening HIV surveillance and preventive efforts among high-risk groups. Second-generation surveillance among MARPs was initiated in 2002. Since then, several rounds of Bio-BSS Surveys have been conducted to measure prevalence of HIV among IDUs and provide measurements of key HIV risk behaviors. According to the last BSS conducted in 2012 among IDUs, in six major cities of Georgia (Tbilisi, Gori, Telavi, Zugdidi, Batumi and Kutiasi) prevalence rates from Batumi and Zugdidi show that the HIV epidemic has reached a concentrated epidemic level. HIV prevalence rangesfrom the lowest 0.4% in Telavi to the highest 9.1% in Zugdidi.

According to the national HIV surveillance system 9.3% in 2012 and 13% in 2013 of all new HIV cases were attributed to the homosexual route of transmission.

The findings of the last Bio-BSS conducted in 2012 among MSM in Tbilisi showed the substantial increase in HIV prevalence within the last two years. The most alarming finding of this study is increase in HIV prevalence from 7% in 2010 to 13% in 2012 proving that HIV epidemic is concentrated among this group of population. High risk practices have not changed over the last two years. There is high sexual activity among MSMs, with risky sexual practices such as frequent change of partners of both sexes, insufficient use of condoms and involvement in group sexual practices. This raises concerns about the bridging role of MSMs in HIV transmission to general population.

As for rates of HIV infection among FSW, these have remained low during the last ten years. According to the recent Bio-BSS among FSWs conducted in 2012 in two cities of Georgia (Tbilisi and Batumi) safe sexual practices are widespread among FSWs. However, condom use rates have slightly decreased with different kinds of partners since 2008, when the previous BSS was conducted. Worsened behavior trend among FSWs (decrease in consistent condom use with the clients in Batumi), indicates the need of continuous provision of prevention information and condoms (especially to the newcomers to Batumi sex business).

(22)

results of Bio-BSS among prisoners conducted in 2012. Explanation of such low prevalence of HIV among prisoners could be found in practical elimination of all HIV-related risk behaviors during the last 3-4 years inside the penitentiary system of Georgia. The increased control of the environment prevented drug and alcohol use, sexual intercourses, and other risky practices, such as tattooing. This is very positive achievement of the system.

In Georgia routine surveillance of pregnant women serves two purposes: 1) to improve early detection of HIV infection among pregnant women and hence prevent mother-to-child transmission risk 2) as a proxy-indicator of HIV prevalence in the general population as HIV prevalence among pregnant women generally is the best available estimate of this. ;

Since 2005 Georgia continues to provide universal access to prevention of mother-to-child transmission (PMTCT) of HIV services, including universal screening of pregnant women for HIV, use of antiretrovirals (ARVs) among HIV positive mothers and their newborns. In 2013, 51,180 pregnant women underwent HIV testing, and among them 22 HIV+ cases were found. 4 pregnant women were <24 years of age and 18 were ≥24. In 2013, HIV testing coverage among pregnant women was 86%. According to the data of last years, coverage of pregnant women by HIV testing is increasing (fig.3).

Figure.3. HIV-testing coverage in pregnant women by years

78% 79% 80% 81% 82% 83% 84% 85% 86% 87% 2009 2010 2011 2012 2013 coverage(%)

HIV-testing coverage in pregnant women by years (%)

In 2013, a total 42 HIV positive pregnant women were in need of ARVs for PMTCT and all of them received the prophylactic treatment.

The successful collaboration of HIV and TB services continue as evidenced by the indicator on co-management of tuberculosis and HIV treatment, with 86% of estimated number of co-infected patients receiving both, TB and HIV treatment. HIV prevalence among TB-patients has slightly increased last years and ranges 3-4%.

Since 2004, through support from the GFATM country has ensured universal access to antiretroviral therapy (ART for all patients in need. It should be mentioned that Georgia remains the only country in the Eastern European region that achieved and maintained universal access to this lifesaving therapy. Georgia is keeping pace with evolving international guidance on ART. At the end of 2013 the country adopted new treatment initiation criteria of CD4 count ≤500 cells/mm3 recommended by 2013 WHO guidelines. Earlier treatment initiation is expected to further improve survival in the country and also to contribute towards prevention of HIV transmission.

At the end of 2013 a total 2092 persons living with HIV were on ART, representing >90% coverage among those who are diagnosed and eligible for treatment.

(23)

III. National Response to the AIDS Epidemic

Due to the recognition of the increased health burden associated with HIV/AIDS, the Government of Georgia has utilized various mechanisms and resources to mitigate the impact of the epidemic. NCDCPH, as a leading organization in the Country responsible for disease control and prevention is implementing several State programs: the HIV/AIDS Prevention and Treatment Program, the Safe Blood program, and the PMTCT program.

The main purpose of the State program on HIV/AIDS prevention is early detection of HIV/AIDS new cases in order to reduce the spread of HIV/AIDS and provide access to treatment for HIV/AIDS patients. This program covers voluntary counseling and testing for high risk groups, including IDUs, TB patients, STI patients, prisoners, patients with hepatitis B and C, patients with clinical signs of HIV/ AIDS, persons having contact with HIV infected people, blood donors, pregnant women, MSMs and FSWs.

State program on HIV/AIDS treatment covers outpatient and inpatient services, while ART is fully funded by the Global Fund. The State program on Safe Blood envisages mandatory testing of all blood donors on HIV, hepatitis B and C infections and Syphilis.

There are 18 Opioid Substitution Therapy (OST) sites in civil sector and 2 sites in penitentiary system over the country. The cumulative number of the patients on OST treatment during 2013 is 4613. Among them 4261 have received OST service in civil sector programs, while 352 persons have been treated in penitentiary system.

HIV voluntary counseling and testing services are available and accessible to all prisoners in all penitentiary facilities in Georgia. By the end of 2012, eighteen VCT service centers were operating in Georgia, with approximately 5600 prisoners receiving HIV counseling and testing annually. Shortly, after the Parliamentary elections in October, 2012, as a result of massive amnesty wave, the number of prisoners decreased drastically. In addition, some prisons were closed permanently due to unacceptable conditions and few became temporarily nonfunctional due to the renovation. By the end of 2013, only 12 facilities were operational in the penitentiary system with around 9,000 prisoners (vs. 24,000 in 2011). HIV counseling and testing services supported by TGF are available in all prisons, and the number of inmates tested on HIV was around 2,000 in 2013. OST (only detoxification) short course is available for drug addicts in only two (#2 and #8) prisons within the frames of the Global Fund HIV grant.

In 2013, as a result of rigorous advocacy initiatives carried out by the Ministry of Corrections in close partnership with civil society organizations and human rights advocates, the Government of Georgia initiated hepatitis B vaccination and hepatitis C testing and treatment program in penitentiary system. The program ensures that all incarcerated persons infected with hepatitis have equal access to hepatitis treatment. Initiation of the program can be considered as one of the most remarkable achievements focused on improving prisoners’ access to health care in closed settings. Palliative care has been recognized as an essential component of a comprehensive package of care for PLWHIV. Since 2008 palliative care services have been operational in Georgia with the aim of improving the quality of life of patients and their families, through the prevention, assessment, and treatment of physical, psychosocial and psychological problems.

Since 2005, Georgia has continued to provide universal access to PMTCT services, including universal screening of pregnant women for HIV, use of antiretrovirals (ARVs) among HIV positive mothers and their newborns. In 2013, a total 42 HIV positive pregnant women were in need of ARVs for PMTCT and all of them received the prophylactic treatment. However, estimates from Spectrum suggest that 62 HIV positive pregnant women were in need of ARVs. Plausible,the Spectrum estimate is an overestimate of actual need. As mentioned above there is universal HIV screening of pregnant women, also there is well established system that ensures rapid linkage to HIV care and comprehensive follow-up of HIV

(24)

Georgia has made substantial progress in HIV/AIDS treatment and care service delivery. Since 2004 through support from the GF the country ensured universal access to ART for all patients in need. It should be mentioned that Georgia remains the only country in the Eastern European region that achieved and maintained universal access to this lifesaving therapy. Georgia is keeping pace with evolving international guidance on ART.At the end of 2013 the country adopted new treatment initiation criteria of CD4 count ≤500 cells/mm3_{recommended by 2013 WHO guidelines. Earlier}

treatment initiation is expected to further improve survival in the country and also to contribute towards prevention of HIV transmission.

Figure.4. Evolving ART Guidelines and Number of HIV Patients on ART in Georgia

At the end of 2013 a total 2092 persons living with HIV were on ART, representing >90% coverage among those who are diagnosed and eligible for treatment. Estimates generated by Spectrum suggests that in 2013 Georgia met 80% of treatment need, and this is the universal access threshold defined by WHO and UNAIDS (indicator 4.1).

Compared to previous years, 2012-2013 showed improvement in survival/retention among patients initiating ART. For example, 12-month retention indicator increased from 79% in 2011 to 86% and 85% in 2012 and 2013 respectively (indicator 4.2a). It should be noted that 24-month retention is 82% (indicator 4.2b) suggesting that major loss occurs within the first year of ART and is primarily attributable to death due to late HIV diagnosis. Retention rates are also high among persons with history of IDU, reaching 80% at 12 months and 79% at 24 months (indicators 4.2.1a and 4.2.1b). This data indicates that Georgia has been successful in providing ART to IDUs, challenging prevalent misconceptions that IDUs may not fully benefit from ART.

Other HIV treatment and care related indicators show accomplishment of the program in Georgia. Overall 81% of those on ART had suppressed viral load, including 84% among those remaining on therapy for 12 months (indicators 4.7a and 4.7b).

HIV and TB services continue successful collaboration as evidenced by indicator Co-management of tuberculosis and HIV treatment, with 86% of estimated number of co-infected patients receiving both TB and HIV treatment.

(25)

IV. Best Practices

Effective mechanisms are in place to promote engagement in care, resulting in high rates of linkage to care. In 2011 over 90% of newly diagnosed patients were linked to HIV clinical care at national or regional facilities. Trusted provider-patient relationships and availability of ancillary services for patients promote high retention, with only a 5% lost in a follow-up rate. ART program data indicates that early attrition largely results from cases of death, which in turn result from late detection of HIV cases.

Other services that contribute to improving quality of life of people living with HIV in Georgia include palliative (institutional and home-based) care, food assistance, close linkages with drug dependence and tuberculosis services and network of patient self-support centers.

Georgia’s achievements in HIV treatment and care represent best practice on a Global scale. International experts describe the Georgian model of HIV treatment and care delivery as exemplary and regard it as the best among countries of former Soviet Union (FSU) and one of the best, if not the best, among low and middle income countries worldwide. The National AIDS Treatment Program has started to operate in 1995 and has been substantially strengthened since 2004 through the resource allocation from the GFATM . GFATM support proved to be critical for scaling-up treatment and care in the country. Since 2004 Georgia remains the only country in Eastern European region that achieved and maintained universal access to antiretroviral therapy. The key to this success is the effectiveness of the program that ensures high engagement of HIV patients in care services. Built on the guiding principles of accessibility, quality and equity of access, the national HIV/AIDS treatment and care program developed multifaceted approach for service delivery. This approach includes: comprehensive HIV-related medical care, close linkages with related medical fields such as tuberculosis and substance abuse, and patient support services, including home-based adherence support.

Recent analysis of cascade of patient engagement in the continuum of HIV care in Georgia showed high rates of engagement of patients in all steps of the continuum of HIV care.

Figure.5. Cascade of HIV Care in Georgia*

*Analysis includes patients diagnosed as of October 2012

(26)

With 84% linkage and 87% retention rates, as well as high treatment coverage, Georgia ranks among the bests worldwide. This high engagement ensures sustainability of universal ART access, which has already translated into significant survival benefit. Mortality analysis over 1989-2012 period showed significant decline, with more than 3-fold reduction in AIDS-related mortality compared to 2004.1

In December 2013 Georgia completed adaption of 2013 WHO guidelines for earlier treatment initiation, and now ART is recommended for all patients with CD4 count <500. Implementation of new guidelines combined with sustained high patient engagement allows Georgia to aim for greater impact on the epidemic in terms of saving lives and preventing new infections. Georgia clearly bears potential of translating treatment as prevention concept into reality, if identification of HIV positive persons is substantially improved in the country.

One of the important recent achievements of Georgian treat